Evaluation of the biomechanics of Aramany class I obturators of different designs using numerical and experimental methods. Part II: Stress distribution.

STATEMENT OF PROBLEM: Evidence regarding stress evaluations of removable obturators with Aramany class I defects is lacking. Whether the stress distribution on Aramany class I prostheses can be improved by modifying the currently used designs is also unclear. PURPOSE: The purpose of part II of this study was to evaluate the stress distribution in different designs of Aramany class I obturators using finite element analysis (FEA) and photoelastic stress analysis. MATERIAL AND METHODS: Four finite element and 8 photoelastic models, including 2 acrylic resin base obturators retained with 2 Adams clasps, 2 linear, 2 tripodal, and 2 fully tripodal design obturators, were used in this study. The frameworks were fabricated on the casts obtained from a modified printed model. Vertical and oblique loads were applied on 2 points (anterior and posterior) of the models. The quantitative measurement was done by measuring the fringe orders and von Mises values to compare the influences of occlusal forces on the obturator components and their supporting structures. The qualitative evaluation was done by visual color mapping to identify the stress concentration. RESULTS: In the photoelastic analysis, the anterior abutments of the tripodal showed the highest stress, followed by the fully tripodal obturators, while, in FEA, the anterior abutments of the linear design received the most in both vertical and oblique load. The central incisor received the most stress in photoelastic (3 or more fringe orders) and FEA (687.3 and 150.1 MPa for vertical and oblique loads, respectively), followed by the lateral incisors. Upon posterior loading, the base of the defect of the linear design demonstrated the most stress in photoelastic (3 or more fringes) and FEA (94.3 and 130.5 MPa for vertical and oblique loads, respectively). The acrylic resin base obturator retained with Adams clasps demonstrated the lowest stress distribution in abutments and their supporting bone upon anterior and posterior loads. CONCLUSIONS: Upon vertical and oblique load application, the fully tripodal design was comparable with the tripodal in terms of stress distribution. Both designs were better than the linear in response to the same loading. The stress was concentrated at the anterior palatal part of the obturator, the base of the defect, and the junction of the metal and acrylic resin part of the prostheses upon anterior and posterior loading, respectively.

Digital comparative analysis in three dimensions of two impression techniques for the bilateral distal extension of partially edentulous mandibular arches: A pilot clinical study.

STATEMENT OF PROBLEM: The stability of mandibular removable partial dentures with bilateral distal extensions may be improved with the controlled tissue support achieved by using the altered cast impression technique, although this process is time-consuming and technique-sensitive. PURPOSE: The purpose of this pilot clinical study was to compare casts generated from a conventional definitive impression with casts generated from an altered cast impression using a 3-dimensional (3D) analysis software program. MATERIAL AND METHODS: Three partially edentulous participants with mandibular Kennedy Class I were enrolled, and impressions were made with the 2 techniques and poured in stone. The casts were scanned, aligned, and superimposed by using a 3D analysis software program. Surface deviations were measured to evaluate the differences in displacement induced by the impression on the tissue surface. Five observations were made in 4 different areas on each partially edentulous side. Means from these observations were generated, and the Wilcoxon and Mann Whitney tests were performed for all data to assess the differences between the right and left sides in the same participant and among the 3 participants (α=.05). RESULTS: The casts made from the altered cast impression had an overall mean ±standard deviation displacement of -0.05 ±1.25 mm on the right and left sides of the mandibular buccal shelf area. Moreover, the greatest overall difference of about 0.45 ±0.41 mm occurred on the lingual slope of the residual ridge, and the differences in the other areas were 0.10 ±0.99 mm (crest of the residual ridge) and 0.16 ±0.66 mm (buccal slope of the residual ridge). The overall differences varied statistically between significance and nonsignificance for the same participant and among the 3 participants. CONCLUSIONS: A digital comparative analysis of the conventional and altered cast methods of recording the bilateral distal extension areas in partially edentulous participants showed that the altered cast method exhibited more displacement on the buccal vestibule or buccal shelf area compared with other examined areas. The differences between the 2 impression methods in the displacement values among the examined areas were minimal and in close proximity, and such differences may lack clinical significance.

Evaluation of the biomechanics of Aramany class I obturators of different designs using numerical and experimental methods. Part I: Retention and associated stress.

STATEMENT OF PROBLEM: Studies on the biomechanics of obturators in the currently used designs of Aramany class I defect are lacking. Also, modifications of the designs presently used in unilateral palatal defects are needed to produce a prosthesis with more retention and less stress on the abutments. PURPOSE: The purpose of part I of this study was to differentiate among Aramany class I obturators of 4 designs regarding retention and associated stress using numerical and experimental methods. MATERIAL AND METHODS: Four finite element models and 36 different base obturators were fabricated and divided into 9 acrylic resin bases retained with Adams clasps and 9 linear, 9 tripodal, and 9 fully tripodal design obturators from casts obtained from a scanned skull. After modification, the prostheses were fabricated on the casts obtained from a 3-dimensionally printed cast. The retention was evaluated, and the data were collected and analyzed using a statistical software program (α=.05). The displacement and associated stress in the assorted casts were compared by using 5-N displacing force at 3 points using finite element analysis. The quantitative assessment was made by measuring the displacement and von Mises stress distribution on the prostheses and their supporting structures. The qualitative analysis was done by using a visual color mapping to depict stress location and intensity. RESULTS: No significant differences were found between fully tripodal (4.478 ±2.303 MPa) and tripodal obturators (4.478 ±2.286 MPa; P=.153), although fully tripodal showed more resistance to anterior displacement (4.522 ±0.979 and 3.553 ±1.58 MPa for fully tripodal and tripodal designs, respectively; P=.007), and tripodal obturators produced more resistance to middle displacement (5.441 ±1.778 and 2.784 ±0.432 MPa for tripodal and fully tripodal design respectively; P=.001). The fully tripodal obturator showed more retention (3.736 ±1.182 MPa) than the linear one (2.493 ±1.052 MPa; P=.001). The maxillary central incisor was the most stressed abutment, followed by the lateral incisor, while the second molar was the least. CONCLUSIONS: Regarding retention, the fully tripodal obturator produces retention comparable with the tripodal and significantly more than the linear. Acrylic resin prostheses retained with Adams clasps may be similar to metal-based prostheses regarding retention and stress distribution on the supporting structures.

Effect of tropical outdoor weathering on the surface roughness and mechanical properties of maxillofacial silicones.

STATEMENT OF PROBLEM: The climate of tropical Southeast Asia includes high humidity and ultraviolet radiation that reduce the lifespan of silicone prostheses by inducing changes in their mechanical properties and color stability. Studies on the surface roughness (SR) and mechanical properties of different silicone elastomers (SEs) subjected to the natural tropical weather of Southeast Asia are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the SR, tensile strength (TS), and percentage elongation (% E) of different SEs subjected to outdoor weathering in the Malaysian climate. MATERIAL AND METHODS: Type-II dumbbell-shaped specimens (N-120) (nonweathered=15, weathered=15) were made from 3 room-temperature vulcanized (A-2000, A-2006, and A-103) and 1 heat-temperature vulcanized (M-511) silicone (Factor II). For 6 months, weathered specimens were subjected to outdoor weathering inside a custom exposure rack. Simultaneously, the nonweathered specimens were kept in a dehumidifier. Subsequently, the SR was measured with a profilometer; TS and % E were measured by using a universal testing machine. Two-way ANOVA was used to compare the means of the tested properties of the nonweathered and weathered specimens, and pairwise comparison was carried out between the silicones (α=.05). RESULTS: After outdoor weathering, the SR, TS, and % E were adversely affected by weathering in the Malaysian environment. Among the silicone materials, A-2000 showed the least TS changes (2.51 MPa), while A-2006 demonstrated significant changes in percentage elongation after outdoor weathering (266.5%). M-511 exhibited the highest mean value (2.50 µm) for SR changes. In addition, A-103 SE showed statistically significant differences in most pairwise comparisons for all 3 dependent variables. CONCLUSIONS: Based on the evaluation of mechanical properties, A-103 can be suggested as a suitable silicone for maxillofacial prostheses fabricated for tropical climates. However, A-2000 can be a suitable alternative, although significant changes to surface roughness were detected after outdoor weathering.

Effect of Aging and Weathering on the Physical Properties of Maxillofacial Silicone Elastomers: A Systematic Review and Meta-Analysis.

PURPOSE: This systematic review aims to identify and interpret results of studies that evaluated the changes in the physical properties of maxillofacial prosthetic materials (1) without aging, (2) after natural or artificial accelerated aging, and (3) after outdoor weathering. METHODS: Relevant articles written in English only, before January 15, 2017, were identified using an electronic search in the PubMed, Scopus, and Google Scholar databases. Furthermore, a manual search of the related major journals was also conducted to identify more pertinent articles. The relevancy of the articles was verified by screening the title, abstract, and full text if they met the inclusion criteria. A total of 37 articles satisfied the criteria, from which data were extracted for qualitative synthesis. RESULTS: Among the 37 included articles, 14 were without aging, 15 were natural or artificial accelerated aging, 7 were outdoor weathering, and 1 contained both artificial aging and outdoor weathering. Only 4 studies out of the 14 without aging had significant observations; whereas 9 articles with natural or artificial aging published significant results, and 3 out of 7 outdoor weathering articles showed significant changes in the evaluated silicone elastomers. CONCLUSIONS: Despite the varying research, it seems that the single "ideal" maxillofacial prosthetic material that can provide sufficient resistance against different aging conditions is yet to be identified. Therefore, it is imperative for standardization organizations, the scientific community, and academia to develop modified prosthetic silicones possessing improved physical properties and color stability, limiting the clinical problems regarding degradation of maxillofacial prostheses.

Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets.

INTRODUCTION: The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets. METHODS: Twenty-two patients (11 male, 11 female; mean age, 19.8 ± 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm2/point; diameter of optical fiber tip, 0.04 cm2) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). RESULTS: Canine retraction was significantly greater (1.60 ± 0.38 mm) on the experimental side compared with the placebo side (0.79 ± 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 ± 0.82 and 1.4 ± 0.64) compared with the placebo sides (2.2 ± 0.41 and 2.4 ± 1.53). CONCLUSIONS: Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it.

Surface Coating of Gypsum-Based Molds for Maxillofacial Prosthetic Silicone Elastomeric Material: Evaluating Different Microbial Adhesion.

PURPOSE: To compare the adhesion of three microorganisms on modified and unmodified silicone elastomer surfaces with different surface roughnesses and porosities. MATERIALS AND METHODS: Candida albicans, Streptococcus mutans, and Staphylococcus aureus were incubated with modified and unmodified silicone groups (N = 35) for 30 days at 37°C. The counts of viable microorganisms in the accumulating biofilm layer were determined and converted to cfu/cm2 unit surface area. A scanning electron microscope (SEM) was used to evaluate the microbial adhesion. Statistical analysis was performed using t-test, one-way ANOVA, and post hoc tests as indicated. RESULTS: Significant differences in microbial adhesion were observed between modified and unmodified silicone elastomers after the cells were incubated for 30 days (p < 0.001). SEM showed evident differences in microbial adhesion on modified silicone elastomer compared with unmodified silicone elastomer. CONCLUSIONS: Surface modification of silicone elastomer yielding a smoother and less porous surface showed lower adhesion of different microorganisms than observed on unmodified surfaces.

New Approach to 3D Printing of Facial Prostheses Using Combination of Open Source Software and Conventional Techniques: A Case Report.

The wax sculpting of a maxillofacial prosthesis is challenging, time-consuming, and requires great skill. Rapid prototyping (RP) systems allow these hurdles to be overcome by enabling the creation of a customized 3D model of the desired prosthesis. Geomagic and Mimics are the most suitable software programs with which to design such prostheses. However, due to the high cost of these applications and the special training required to operate them, they are not widely used. Additionally, ill-fitting margins and other discrepancies in the final finished products of RP systems are also inevitable. Therefore, this process makes further treatment planning difficult for the maxillofacial prosthodontist. Here, we report the case of a 62-year-old woman who attended our clinic. Initially, she had presented with a right facial defect. This was later diagnosed as a squamous cell carcinoma and resected. The aim of this report is to describe a new technique for the 3D printing of facial prostheses which involves the combined use of open-source software, an RP system, and conventional methods of fabrication. The 3D design obtained was used to fabricate a maxillofacial prosthesis to restore the defect. The patient was happy with the esthetic outcome. This approach is relatively easy and cheap, does not require a high degree of non-medical training, and is beneficial in terms of clinical outcome.

Cementoblastic lineage formation in the cross-talk between stem cells of human exfoliated deciduous teeth and epithelial rests of Malassez cells.

OBJECTIVES: The purpose of this study was to evaluate the synergistic effect of epithelial rests of Malassez cells (ERM) and transforming growth factor-ß1 (TGF-ß1) on proliferation, cementogenic and osteogenic differentiation of stem cells derived from human exfoliated deciduous teeth (SHED). MATERIALS AND METHODS: SHED were co-cultured with ERM with/without TGF-ß1. Then, SHED proliferation, morphological appearance, alkaline phosphatase (ALP) activity, mineralization behaviour and gene/protein expression of cemento/osteoblastic phenotype were evaluated. RESULTS: TGF-ß1 enhanced SHED proliferation when either cultured alone or co-cultured with ERM. ERM induced the cementoblastic differentiation of SHED which was significantly accelerated when treated with TGF-ß1. This activity was demonstrated by high ALP activity, strong mineral deposition and upregulation of cementum/bone-related gene and protein expressions (i.e. ALP, collagen type I, bone sialoprotein, osteocalcin and cementum attachment protein). CONCLUSIONS: ERM were able to induce SHED differentiation along the cemento/osteoblastic lineage that was triggered in the presence of TGF-ß1. CLINICAL RELEVANCE: The cemento/osteoblastic differentiation capability of SHED possesses a therapeutic potential in endodontic and periodontal tissue engineering.

Surface Coating of Gypsum-Based Molds for Maxillofacial Prosthetic Silicone Elastomeric Material: The Surface Topography.

PURPOSE: This study aimed to compare the surface roughness of maxillofacial silicone elastomers fabricated in noncoated and coated gypsum materials. This study was also conducted to characterize the silicone elastomer specimens after surfaces were modified. MATERIALS AND METHODS: A gypsum mold was coated with clear acrylic spray. The coated mold was then used to produce modified silicone experimental specimens (n = 35). The surface roughness of the modified silicone elastomers was compared with that of the control specimens, which were prepared by conventional flasking methods (n = 35). An atomic force microscope (AFM) was used for surface roughness measurement of silicone elastomer (unmodified and modified), and a scanning electron microscope (SEM) was used to evaluate the topographic conditions of coated and noncoated gypsum and silicone elastomer specimens (unmodified and modified) groups. After the gypsum molds were characterized, the fabricated silicone elastomers molded on noncoated and coated gypsum materials were evaluated further. Energy-dispersive X-ray spectroscopy (EDX) analysis of gypsum materials (noncoated and coated) and silicone elastomer specimens (unmodified and modified) was performed to evaluate the elemental changes after coating was conducted. Independent t test was used to analyze the differences in the surface roughness of unmodified and modified silicone at a significance level of p < 0.05. RESULTS: Roughness was significantly reduced in the silicone elastomers processed against coated gypsum materials (p < 0.001). The AFM and SEM analysis results showed evident differences in surface smoothness. EDX data further revealed the presence of the desired chemical components on the surface layer of unmodified and modified silicone elastomers. CONCLUSIONS: Silicone elastomers with lower surface roughness of maxillofacial prostheses can be obtained simply by coating a gypsum mold.

Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment.

The need for orthodontic treatment is increasing all the time. As the treatment is time consuming ranging from a year to several years, any method of reducing the period of treatment and increasing the quality of the tissue will be beneficial to patients. The use of non-invasive techniques such as low level laser therapy and low intensity pulsed ultasound in accelerating orthodontic tooth movement are promising. Thus, this overview study will help to generate more understanding about the background information and the possible applications of them in daily orthodontics, depending on previous literature searching for reviews and original research articles.

Applications of artificial intelligence in restorative dentistry: a scoping review.

OBJECTIVE: Artificial intelligence (AI) applications in restorative dentistry have remarkably increased in the past 5 years. This review outlines the applications, promises, and limitations of AI in the most performed procedures in restorative dentistry. METHOD AND MATERIALS: An electronic search was performed in four databases: MEDLINE/PubMed, Embase, Web of Science, and Scopus. The search included articles published in English language without date restriction. Two independent reviewers assessed the eligibility of the studies and performed data extraction. Any discrepancy was resolved by the consensus of a third reviewer. RESULTS: A total of 33 studies were included in this review. For AI applications in restorative dentistry, the included studies were classified into three main groups: (1) diagnosis, detection, and prediction of the disease, (2) detection and prediction of the longevity of dental restorations, and (3) teeth detection and treatments. For each study, the AI model, type of dataset, sample size, and main results (accuracy, precision, sensitivity, and specificity) were reported. CONCLUSIONS: AI systems are promising as advantageous aids for diagnosis, prediction, and treatment in dentistry, with a high degree of accuracy. Despite the AI promises, several limitations are still unresolved and must be addressed to bridge the gap between technology and clinical applications.

Three-dimensional analysis of reconstructed skulls using three different open-source software versus commercial software.

This study aimed to compare the 3D skull models reconstructed from computed tomography (CT) images using three different open-source software with a commercial software as a reference. The commercial Mimics v17.0 software was used to reconstruct the 3D skull models from 58 subjects. Next, two open-source software, MITK Workbench 2016.11, 3D Slicer 4.8.1 and InVesalius 3.1 were used to reconstruct the 3D skull models from the same subjects. All four software went through similar steps in 3D reconstruction process. The 3D skull models from the commercial and open-source software were exported in standard tessellation language (STL) format into CloudCompare v2.8 software and superimposed for geometric analyses. Hausdorff distance (HD) analysis demonstrated the average points distance of Mimics versus MITK was 0.25 mm. Meanwhile, for Mimics versus 3D Slicer and Mimics versus InVesalius, there was almost no differences between the two superimposed 3D skull models with average points distance of 0.01 mm. Based on Dice similarity coefficient (DSC) analysis, the similarity between Mimics versus MITK, Mimics versus 3D Slicer and Mimics versus InVesalius were 94.1, 98.8 and 98.3%, respectively. In conclusion, this study confirmed that the alternative open-source software, MITK, 3D Slicer and InVesalius gave comparable results in 3D reconstruction of skull models compared to the commercial gold standard Mimics software. This open-source software could possibly be used for pre-operative planning in cranio-maxillofacial cases and for patient management in the hospitals or institutions with limited budget.

Isolation and enhancement of a homogenous in vitro human Hertwig's epithelial root sheath cell population.

Hertwig's epithelial root sheath (HERS) cells play a pivotal role during root formation of the tooth and are able to form cementum-like tissue. The aim of the present study was to establish a HERS cell line for molecular and biochemical studies using a selective digestion method. Selective digestion was performed by the application of trypsin-EDTA for 2 min, which led to the detachment of fibroblast-like-cells, with the rounded cells attached to the culture plate. The HERS cells displayed a typical cuboidal/squamous-shaped appearance. Characterization of the HERS cells using immunofluorescence staining and flow cytometry analysis showed that these cells expressed pan-cytokeratin, E-cadherin, and p63 as epithelial markers. Moreover, RT-PCR confirmed that these cells expressed epithelial-related genes, such as cytokeratin 14, E-cadherin, and ΔNp63. Additionally, HERS cells showed low expression of CD44 and CD105 with absence of CD34 and amelogenin expressions. In conclusion, HERS cells have been successfully isolated using a selective digestion method, thus enabling future studies on the roles of these cells in the formation of cementum-like tissue in vitro.

Sealing ability of various restorative materials as coronal barriers between endodontic appointments.

AIM: To evaluate and compare the microleakage of various restorative materials used as coronal barriers between endodontic appointments. MATERIALS AND METHODS: Eighty extracted human permanent posterior teeth were prepared for standardized access cavities with dimensions of 4 × 4 × 4 mm. The teeth were then randomly divided into four groups; Kalzinol, Caviton, GC Fuji IX and GC Fuji II LC. After incubation, the samples were immersed in 2% methylene blue for 7 days. The depth of penetration was measured using a digital macroscope after longitudinal sectioning of each tooth. Kruskal-Wallis (p < 0.05) and multiple Mann-Whitney test with Bonferroni correction (p < 0.008) were used for data analysis. RESULTS: The degree of microleakage varied at the material/ tooth interface among the test materials, and the difference was statistically significant (p < 0.05). GC Fuji II LC group showed the least median microleakage value (0.8105 ± 0.305), followed by Caviton (1.1885 ± 0.396), GC Fuji IX (3.3985 ± 0.305) and Kalzinol (4.161 ± 0.853). CONCLUSION: Within the limitations of this study, GC Fuji II LC exhibited the best marginal seal, and has the potential to be used as a suitable coronal barrier between endodontic appointments. CLINICAL SIGNIFICANCE: Given the prime importance that dental practitioners should thoroughly restore any tooth with a suitable coronal barrier between endodontic appointments, this study shows that Fuji II LC has the ability to maintain a hermetic seal for 7 days.

Effects of Low-Level Laser Therapy and Bracket Systems on Root Resorption during Orthodontic Treatment: A Randomized Clinical Trial.

This study aimed to assess the outcomes of low-level laser therapy (LLLT) with the conventional bracket (CB) and self-ligating (SL) bracket systems on root resorption (RR) during orthodontic treatment. A total of 32 patients were included in this randomized clinical trial. All the patients were randomly divided into four individual groups (SLL: self-ligating laser, CBL: conventional bracket laser, SLNL: self-ligating non-laser, CBNL: conventional bracket non-laser). RR was measured from the cone-beam computed tomography (CBCT) radiographs which were taken at two stages of the orthodontic treatment: pre-treatment (T1) and after leveling and alignment stage (T2). Wilcoxon rank test for the comparison was conducted to compare the RR at T1 and T2 stages within each group and showed a significant difference (p < 0.05) for various variables. Mann Whitney test compared the RR in laser and non-laser groups irrespective of the bracket systems and exhibited no significant differences except the left lateral incisor. Moreover, CB and SL groups showed no significant difference in RR among any tooth. Kruskal Wallis test was performed to compare the RR among all groups which presented no significant differences. LLLT and bracket systems have no consequences on RR until the leveling and alignment stage of orthodontic treatment.

Development of Artificial Neural Network-Based Prediction Model for Evaluation of Maxillary Arch Growth in Children with Complete Unilateral Cleft Lip and Palate.

INTRODUCTION: Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals. METHODS: This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen. RESULTS: The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study's output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%. CONCLUSION: The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.

Minimum Intervention in Managing Two Cases of Tetracycline Staining of Different Severity.

Patient dissatisfaction with tooth discoloration as a result of tetracycline therapy is not uncommon. To address patients' aesthetic demands, conservative bleaching treatments were considered before more invasive, irreversible treatments such as dental veneers or crowns. Bleaching is a relatively non-invasive, safe, and cost-effective method of achieving a desirable result. However, due to many limiting variables, including the extended duration of active bleaching, tetracycline-stained teeth are one of the most challenging cases to obtain satisfactory bleaching outcomes. This clinical report presents two cases of management of tetracycline staining of the teeth with varying degrees of severity.